HEALTH CARE REFORM AND THE IMPACT ON VULNERABLE POPULATIONS IN ILLINOISStephanie Altman, Programs & Policy Directorsaltman@hdadvocates.org John Bouman, President, Shriver National Center on Poverty Law, johnbouman@povertylaw.orgNelson Soltman, Supervisory Attorney, LAFMC, nsoltman@lafchicago.org

KEY COMPONENTS OF AFFORDABLE CARE ACT Individual Responsibility (the “individual mandate”) Employer Responsibility (the “employer mandate”)

Employers with 50 or more employees are required to offer coverage or pay a “free rider” penalty if one of their employees is eligible for and receives a subsidy to purchase insurance through the exchange.

Create state-based “Exchanges” through which individuals and small businesses (# of employees to be determined by state) can purchase coverage. Premium and cost-sharing credits available to

individuals/families with income between 100-400% FPL. “Qualified health plans“ will be sold through the

exchanges Large Expansion of Medicaid to Childless Adults up to 138%

FPL. Significant Private Insurance Market Reforms including

elimination of underwriting based on health status and ban on pre-existing condition exclusions.

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ESSENTIAL BENEFITS PACKAGE The minimum contents of

the essential health benefits package, which will be detailed in regulations to be issued in 2012, comprise the following categories mandated in the Affordable Care Act (all health plans sold through the health care exchange must cover the essential benefits package at a minimum):

Ambulatory patient services; Emergency services; Hospitalization; Maternity and newborn care; Mental health and substance

use disorder services; Prescription drugs; Rehabilitative and

habilitative services and devices;

Laboratory services; Preventive and wellness

services including chronic disease management;

Pediatric services including oral and vision care.

STATUS OF ACA LITIGATION

Circuit Court Decisions and the “Individual Mandate”

Can the ACA survive without the individual mandate?

Supreme Court Cert in Virginia and Florida Case

Political Considerations in Congress of the “threat” to repeal and replace.

MEDICAID IN ILLINOIS NOW

Medicaid Categorical Eligibility (All Kids; Family Care; Moms and Babies; AABD; GA/TA)

The Disability Determination: SSI and SSDI

Medicaid Medically Needy (Spend down)

Medicaid Buy-In for Workers with Disabilities

Medicaid Home and Community Based Waivers

ILLINOIS MEDICAID 2010- 2014

Same mandatory and optional categories.

Maintenance of Effort Provision (exceptions: All Kids; Family Care; Illinois Cares Rx; Provider Reimbursement.)

Option to cover individuals in “newly eligible” below the 138% FPL category prior to 2014.

MEDICAID EXPANSION IN 2014 In 2014, anyone up to 133% FPL is eligible for Medicaid,

called “newly eligible” Medicaid. Must be under 65, not entitled to or enrolled in Medicare A or

enrolled in Part B. Modified gross income test and no asset test, which is different from

current Medicaid and SCHIP Programs.

Federal government pays for much greater percentage of this expansion.

Potential to alleviate challenge of the Medicare waiting period – dependent upon coverage package.

Most applications will be filed electronically through a Health Insurance Exchange. Others will be filed through more traditional methods.

ENROLLMENT AND ELIGIBILITY ISSUES IN 2014

Enrollment Procedures for Medicaid and Health Care Exchange applications online, by mail and in person

Eligibility Determinations Due Process Issues

GOING BACKWARD BEFORE WE GO FORWARD Medicaid Reform Legislation passed in Illinois

in December 2010 and signed by Governor Caps All Kids at 300% FPL for new enrollees

after 7/1/2011. Grandfathers in current All Kids enrollees

over 300% FPL until 7/1/2012. Imposed new verification and eligibility

barriers for Medicaid which have been disallowed by CMS.

Imposes moratorium on Medicaid expansions until 2013.

Requires 50% of Medicaid enrollees to be in risk based coordinated care by 2015. 9

INTEGRATED CARE PILOT

Pilot project for enrollment of 40,000 AABD recipients (non-dual eligibles) into managed care.

Cook and Collar Counties with exception of City of Chicago.

Enrollment through Illinois Health Connect and managed care through Aetna and Illinicare.

Network issues and exception policies. Single Care Agreements and Continuity of

Care.

HEALTH CARE REFORM IMPLEMENTATION IN ILLINOIS: ILLINOISHEALTHMATTERS.ORG

Governor Quinn signed an executive order on July 30, 2010 to create the Illinois Health Care Reform Implementation Council to help implement ACA.

The council issued recommendations to: establish a health insurance exchange and other consumer

protection reforms; reform Medicaid; assure high quality care; identify federal grants and other non-governmental

funding sources; and foster the widespread adoption of electronic medical

records.

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ACA PROVISIONS ALREADY IN PLACE

IPXP: Illinois Preexisting Insurance Program at http://insurance.illinois.gov/ipxp/

Dependent Coverage up to age 26. No pre-existing condition exclusions or denial

of coverage based on health status for children.

Small Business Tax Credits available. Insurance Rescissions are only allowed in

cases of intentional fraud or intentional misrepresentation.

HEALTH CARE EXCHANGE LEGISLATION SB 1555 (now Public Act 097-0142) was signed

into law in August 2011 by the Governor. Creates a Legislative Task Force to Recommend

Implementation and Design of the Illinois Health Care Exchange.

Governance and Financial Sustainability are the major issues.

Recommendations are due by Veto Session 2011 in order to continue to receive federal funding for the implementation planning process.

State must continue to progress toward an implementation design and then get approval for final implementation by January 1, 2013 to continue to get federal funding. 13

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Illinois Health Matters, a website, Facebook page and Twitter feed, on health care reform in Illinois, is producing multimedia snapshots on how the Affordable Care Act is affecting or will affect the residents in the South and West Sides of Chicago. See our Neighborhood Stories site here:http://www.illinoishealthmatters.org/neighborhood-stories.aspx